Cox Market  -- PRINTABLE ORDER FORM


Print this form and mail money order or
 personal check payable to:  Gladys Cox

Cox Market
Gladys Cox
288 Flannagan Drive
Bristol VA 24202
276-669-9047


 

 

http://www.coxmarket.com

Name:

Please note any special instructions or comments here:

Street Address:

 

City, State, Zip:
Email Address:
Telephone:

Please include name, address, email and telephone number on all correspondences

Product / Description

Quantity

Total Price

     
     
     
     
     
     
     
     
     
 

Subtotal

 
Tip:  Contact us (gladys@coxmarket.com) in advance of your order intentions and your zip code.  We will calculate the shipping charge for you and notify you prior to completing the order.

Shipping
/handling

 

Total Enclosed:

 

Cox Market - Gladys Cox - 288 Flannagan Drive
Bristol, VA, 24202;  Phone: 276-669-9047

Thank You For Your Order!
Your Order Will Be Processed Upon Receipt Of Payment.